BACKGROUND AND PURPOSE:

• There is limited evidence regarding the best approach for repair of vaginal apex prolapse
• Anand et al. (Female Pelvic Medicine Reconstructive Surgery, 2017) assessed treatments for posthysterectomy vaginal vault prolapse
• Hypothesis: Rates of symptom relief and survival free of retreatment would be higher in the open abdominal sacrocolpopexy group compared to Robotic and Mayo-McCall culdoplasty

METHODS:

• Retrospective cohort study of patients who underwent surgery for posthysterecotmy apical vaginal prolapse
• Authors compared degrees of symptom relief and survival free of retreatment after
  • Mayo-McCall culdoplasty (MMC)
    • Modification of uterosacral ligament suspension
  • Open abdominal sacrocolpopexy (ASC)
  • Robotic sacrocolpopexy (RSC)
• Baseline characteristics, intraoperative and postoperative outcomes were taken from electronic health records
• Patients answered validated questionnaires to acquire cross-sectional data for current pelvic floor symptoms
• Propensity score methodology was used to deal with patient selection bias

RESULTS:

• 512 women were included in the cohort study
  • 337 completed the questionnaire
  • Median follow up was 4.5 years for the MMC group | 5.2 years for the ASC group | 2.9 years for the RSC group
• There was no significant difference between groups for:
  • Overall Pelvic Floor Distress Inventory 20
  • Pelvic Floor Impact Questionnaire Short Form 7
  • Pelvic Organ Prolapse/Urinary Incontinence Sexual Function Questionnaire 12 summary scores
• There were no significant differences in 5-year survival free of retreatment for
  • MMC (94.0%) vs RSC (95.5%)
  • ASC (94.8%) vs RSC (92.1%)
• There were significantly more patients that underwent retreatment in the first 10 years in the MMC (81.1% survival free of retreatment) vs ASC group (95.4% survival free of retreatment)
  • Hazard Ratio 3.68 (95% CI 1.51-8.98)
• 10-year follow-up data for RSC comparisons was not included for historical reasons (recent entry of RSC as a surgical alternative)

CONCLUSION:

• Symptom relief and 5-year retreatment rates were similar between the MMC, ASC, and RSC groups
• Compared to MMC, ASC is more durable, with higher survival free of retreatment within 10 years, although MMC still had favorable rates

Learn More – Primary Sources:

Symptom Relief and Retreatment After Vaginal, Open, or Robotic Surgery for Apical Vaginal Prolapse.

Related ObG Topics:

Mesh and Pelvic Organ Prolapse: ACOG Practice Advisory & ACOG/AUGS Recommendations 

Comparing the Use of Mesh Against Standard Repair for Prolapse

Is Pelvic Muscle Strengthening Effective Following Pelvic Surgery for Prolapse and Incontinence?